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Difficulty: HardSomatic Symptom and Eating Disorders

Which psychiatric diagnosis or behavioral characterization best corresponds to each of the following patient scenarios?

  • A 35-year-old paralegal reports persistent, migrating abdominal pain and severe fatigue for eight months. Despite multiple negative endoscopies and CT scans, she spends several hours each night researching potential undiagnosed malignancies and frequently changes physicians.Somatic symptom disorder
  • A 42-year-old accountant has a six-month history of intense fear regarding pancreatic adenocarcinoma following a relative's recent death. He reports occasional mild dyspepsia, has completely normal diagnostic workups, yet insists on monthly abdominal ultrasounds to ensure nothing was missed.Illness anxiety disorder
  • A 29-year-old phlebotomist is admitted with polymicrobial bacteremia involving skin flora. Intravenous antibiotics are started, but blood cultures repeatedly remain positive. A search of her hospital room reveals concealed non-sterile syringes. She has no pending lawsuits or disability claims.Factitious disorder imposed on self
  • A 31-year-old warehouse worker reports bilateral lower extremity paralysis following a minor slip at work. Complete neurological examination and spinal MRI are unremarkable. He is actively suing his employer for permanent disability compensation and becomes hostile when discharged.Malingering

Answer

The scenarios represent Somatic symptom disorder, Illness anxiety disorder, Factitious disorder imposed on self, and Malingering, respectively.
Correct matching distinguishes the somatic spectrum by evaluating the prominence of physical symptoms (Somatic symptom vs. Illness anxiety) and the motivation for deceptive behaviors (primary gain in Factitious disorder vs. secondary gain in Malingering).

Step-by-Step Solution

1
Evaluate symptom severity and health-related behaviors for unconscious disorders.
The paralegal has prominent somatic symptoms and excessive thoughts about them (Somatic symptom disorder), whereas the accountant has minimal symptoms but extreme anxiety about acquiring a disease (Illness anxiety disorder).
Differentiates between Somatic symptom disorder and Illness anxiety disorder based on the physical symptom burden.
2
Assess for evidence of deception or intentional symptom fabrication.
Both the phlebotomist and the warehouse worker exhibit clear signs of feigned or self-induced illness, ruling out unconscious disorders like conversion disorder.
Identifies intentionality as the key driver of the clinical presentation.
3
Determine the underlying motivation for deceptive behavior.
The phlebotomist seeks the sick role (primary gain), indicating Factitious disorder, while the warehouse worker seeks financial compensation (secondary gain), indicating Malingering.
Differentiates between Factitious disorder and Malingering based on the presence of external rewards.

Key Concept

Differential diagnosis of somatic symptom and related disorders based on symptom severity, symptom intentionality, and underlying motivation.
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Topics

Somatic Symptom and Eating Disorders

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